PICO? Double Blinded? The Curiosity That Gave Birth to a Research Passion

Omneya Kandil

My first encounter with research was as an exchange student in Indonesia. I remember hearing terms such as "double blinded study" and thought to myself, if neither the researchers nor the participants know which treatment is given, then who does? Why even have it double blinded? I can now say that  this moment of reflection and curiosity was the matchstick that lit the flame of love and passion I have for research.

During my rotation in Indonesia, I was fortunate to witness the undertakings of a trial from beginning to end – from the codes that were sent to the hospital for drug distribution, to each patient obtaining the drugs, and follow up arrangements to assess response and adverse effects related to the drug. For instance, certain techniques like pill-counting to assess adherence to treatment was intriguing to me.

What does the mention of the word, PICO, bring to your mind? Is it Pico Island in Portugal? Or Pico from the video game, Pico's School?

There is another PICO of which you may not have heard, as I had not at the beginning of my rotation. I’m referring to the PICO framework, which lays the foundation of evidence-based medicine. It is a mnemonic consisting of the elements of a good clinical question that a researcher tries to answer, which aids him in his literature search: Population, intervention, comparator, and outcome. An example of a PICO question would be "Would antibiotics (intervention) affect sputum production (outcome) in patients who have pneumonia (population) compared to no antibiotics (comparator)?"

There are different variations to PICO, such as PICOT, which takes time into consideration, or PIC (population, interest, context) and PEO (population, exposure, outcome), which are used for qualitative studies. I am happy to say that by the end of my stay in Indonesia, I was able to bring to fruition a research idea, guided by the PICO technique. I wrote an abstract regarding prognostic values of the TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) risk scores in patients with acute coronary syndrome. My PICO framework was as follows:

[P] Patients with acute coronary syndrome,

[I] GRACE risk score,

[C] TIMI risk score,

[O] better prognostic performance to guide clinical management and therapeutic decision making.

You may wonder, "Why use the PICO method and what is evidence-based medicine?" Evidence-based medicine helps shape guidelines that doctors use when tailoring treatment plans for patients.

To grow in research – and to author multiple papers – you have to strengthen your curiosity muscle. The curiosity and eagerness to discover by reading more and synthesizing more information is what will keep you going and help you ask smarter questions and develop better PICOs over time. The reason we pursue the medical field is to help people live better and achieve a better quality of life. In my opinion, research is one way doctors can achieve this. Research equals new hopes and leads to better lives – which is why research training should be paramount in medical school.

Omneya Kandil

This article was written by Omneya Kandil, a medical student at Alexandria Faculty of Medicine. Twitter: @OmneyaKandil

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